2014 - Ba - Readiness Quiz Final - Ga/Df

OneExchange is a company that offers a range of services. It is the largest private healthcare exchange in the nation, providing individuals with a one-stop shop for their healthcare needs. Additionally, OneExchange assists companies in enhancing retiree healthcare by providing guidance and support. Therefore, the correct answer is "All of the above" as it encompasses all the services provided by OneExchange.

Microsoft Outlook is a software program that primarily functions as an email client. It allows users to send, receive, and manage their emails efficiently. Outlook also offers additional features such as organizing emails into folders, scheduling appointments and meetings, managing contacts, and integrating with other Microsoft Office applications. Therefore, the correct answer is "Email."

Medicare Part A refers to hospital coverage. This means that it covers inpatient care in hospitals, skilled nursing facilities, and hospice care. It also includes limited coverage for home health care services. Medicare Part A is one of the four parts of the Medicare program, which provides health insurance for individuals who are 65 years old or older, as well as certain younger individuals with disabilities.

The Rx Profiler is located in SSC.

The section that is not found in the client guide is "Available plans". This means that the client guide does not provide information or details about the different plans that are available. The guide may include information about mailers, funding, and enrollment, but it does not cover the available plans.

If a drug is identified as non-covered, the best step to take would be to re-verify the drug with the customer to ensure accuracy. Additionally, checking for the correct spelling of the drug is important to avoid any confusion or errors. Lastly, checking the drug on Medicare.gov can provide further information on coverage and eligibility. Therefore, all of the above steps are necessary to address the issue of a non-covered drug.

The correct answer is SSC. After pinning the icon EH to the taskbar, it provides a quick way to open the SSC program.

To answer the supervisor's question directly, the most appropriate method would be to use the "Reply" option. This allows you to respond directly to the sender without involving all the other recipients of the email. Using "Reply all" would include everyone in the email thread, which may not be necessary if the question is specific to the supervisor. Forwarding the email would pass the responsibility to someone else, and following up may not directly address the supervisor's question.

The explanation for the correct answer, False, is that when verifying the Medicare claim number, it is not advised to tell the retiree that their Medicare claim number is their Social Security number with a letter at the end. This is because sharing personal information like the Social Security number can pose a risk to the retiree's privacy and security. It is important to handle personal information with care and follow proper protocols for verifying and protecting sensitive data.

The statement is false because Medicare Part A and B effective dates can be different. Medicare Part A is usually effective from the first day of the month an individual turns 65 or becomes eligible due to a disability, while Medicare Part B can have a different effective date depending on when the individual enrolls. Therefore, the effective dates for Medicare Part A and B are not always the same.

Special consideration is needed when selecting a plan for someone who is in a nursing home. Nursing home residents often have specific healthcare needs that require personalized care and attention. Factors such as medication management, specialized therapies, and assistance with daily activities need to be taken into account when choosing a suitable plan for them. Therefore, it is false to say that no special consideration is needed in this situation.

During the time period from October 15 to December 7, customers are able to change a CMS plan. This period is known as the Annual Election Period, which allows customers to make changes to their plan, such as switching to a different CMS plan or enrolling in a new plan altogether. This time frame is specifically designated for customers to review their options and make any necessary changes to their healthcare coverage.

HMOs, or Health Maintenance Organizations, typically require their members to have a primary care physician (PCP) number. This means that individuals enrolled in an HMO must choose a primary care doctor who will serve as their main point of contact for all their healthcare needs. The PCP will coordinate and manage their overall healthcare, including referrals to specialists and ordering necessary tests or treatments. This requirement helps ensure that healthcare is coordinated and that individuals receive appropriate and timely care. Therefore, the statement "HMOs require a primary care physician number" is true.

The Client Guide provides information about a customer's current or former employer. This information is used to research networks for doctors and hospitals, plans offered according to zip codes, and to explain deductibles. The guide contains specific details that are relevant to the customer's employer, such as the coverage options available, network providers associated with the employer, and any unique benefits or discounts offered through the employer. This information helps the customer make informed decisions about their healthcare options based on their current or previous employment.

Step therapy is a type of drug restriction where patients are required to try less expensive or alternative medications before they can access more expensive or advanced treatments. This approach is commonly used by insurance companies to control costs and ensure that patients receive the most appropriate and cost-effective treatment for their condition. By implementing step therapy, insurance providers can encourage the use of lower-cost drugs and reserve more expensive options for cases where they are truly necessary.

Retirees are not required to attend a retiree meeting prior to enrolling in plans with OneExchange.

A deductible for a PDP refers to a fixed amount that an individual must pay out of pocket before their insurance plan starts covering the costs. This amount is predetermined and does not change based on tier levels or percentages of the cost. Therefore, the correct answer is "A fixed amount that must be paid before the plan pays."

The explanation for the given correct answer (False) is that the statement is incorrect. A gap plan does not exempt the customer from paying the Part B premium. Therefore, choosing a gap plan does not eliminate the need to pay the premium, and the statement is false.

The carrier guide can help with finding a doctor, finding a hospital, and finding value-added benefits. However, it cannot help with finding quotable premiums. This means that the carrier guide does not provide information or assistance in obtaining insurance premium quotes.

The tab "Medicare costs" is not found under work resources. This implies that the other three tabs, namely "Call guides," "Speed sheets," and "State guide," are found under work resources.

Part A does not cover physician services. Physician services are covered under Part B of Medicare. Part A mainly covers hospital stays, skilled nursing facility care, and some home health care services.

A Health Maintenance Organization (HMO) has a distinct requirement that some other Medicare Advantage plans do not have, which is the presence of networks. Networks consist of a specific group of doctors, hospitals, and other healthcare providers that have agreed to provide services to the members of the HMO. This means that HMO members can only receive covered healthcare services from providers within the network, and out-of-network services may not be covered or may have higher costs. Therefore, the correct answer is "Has networks."

To be compliant when securing the call with the retiree, the phone number, last 4 digits of the SS number, and date of birth must be obtained. This information helps to verify the identity of the retiree and ensure that the call is being conducted with the correct person. Gender is not necessary for compliance purposes in this scenario.

Preferred Network Pharmacies typically have lower costs for covered drugs compared to other types of pharmacies. This is because they have negotiated lower prices with the insurance plans and offer discounted rates to plan members. Long Term Care Pharmacies, on the other hand, specialize in providing medications to residents of long-term care facilities and may not have the same cost-saving agreements in place. Network Pharmacies may or may not offer discounted rates, depending on their agreements with the insurance plans. The statement "There is no difference in costs on Medicare PDP's" is incorrect as there can be variations in costs depending on the type of pharmacy.

Selecting a pharmacy in the Rx Profiler prior to searching plans will save the BA time in determining whether the customer's pharmacy is a preferred or network pharmacy. This is because by selecting a pharmacy beforehand, the BA can filter the plans based on the preferred or network pharmacies associated with that specific pharmacy. This eliminates the need for the BA to manually check each plan to determine if the customer's pharmacy is included in the network, saving time and effort.

Part B is also known as Medical insurance. This statement is true. Part B refers to the medical insurance coverage provided by Medicare. It helps cover medically necessary services such as doctor's visits, outpatient care, preventive services, and durable medical equipment. Part B is one of the two main parts of Original Medicare, the other being Part A which covers hospital insurance.

The correct answer is "It helps subsidize their new premiums". This explanation is important because it highlights the role of HRA in assisting retirees with their new premiums. By subsidizing their premiums, the HRA helps reduce the financial burden on retirees and ensures that they do not have to pay the full amount out of pocket. This information is crucial to communicate to retirees during calls as it helps them understand the financial support they can expect from the HRA.

The Medicare Initial Coverage Election Period is 7 months long. This period allows individuals who are newly eligible for Medicare to enroll in a Medicare Advantage or Medicare Prescription Drug Plan. It starts three months before the month of their 65th birthday and ends three months after the month of their 65th birthday. This gives individuals a total of 7 months to make their initial coverage election.

The statement suggests that the fastest way to access the client guide during a call with a customer is through the SSC (presumably meaning the Service Support Center or a similar system). This implies that the SSC provides quick and easy access to the necessary information or resources needed to assist the customer. Therefore, the correct answer is True.

If you travel and need a Medicare Advantage Plan that offers coverage outside of the network, the plan you would choose is a PPO (Preferred Provider Organization). PPO plans allow you to receive healthcare services from both in-network and out-of-network providers. This means that even if you are traveling and need medical attention, you can still receive coverage and benefits from your PPO plan.

The statement suggests that collecting information about OTC drugs is important for customers to have a fair comparison of their total monthly drug cost. However, OTC drugs are typically not covered by insurance plans and are purchased directly by the customer without a prescription. Therefore, including the cost of OTC drugs in the comparison of total monthly drug cost would not be relevant or accurate. Hence, the answer is false.

If a customer wanted a Medigap Plan that had a network, they would choose the "Select" plan. The Select plan is a type of Medigap plan that requires beneficiaries to use a network of healthcare providers in order to receive full coverage. This means that if the customer goes outside of the network, they may have to pay higher out-of-pocket costs. Therefore, the Select plan is the best option for someone who wants a Medigap plan with a network.

The statement is incorrect. Medigap plans are not always the first option when selling a plan. Medigap plans, also known as Medicare Supplement plans, are additional insurance policies that can be purchased to cover the gaps in Original Medicare. However, there are other options available such as Medicare Advantage plans, which provide an alternative way to receive Medicare benefits. Therefore, Medigap plans are not always the first choice when selling a plan.

To ensure that the step of linking or adding a member to an existing account is completed correctly, it would be best to ask Infosource for assistance. Infosource is likely to have the necessary information and resources to guide and support in completing the task accurately. Contacting ADP may not provide the specific guidance needed for this task, transferring to a CSR may not guarantee the right expertise, and completing the task oneself may lead to errors or lack of knowledge. Therefore, asking Infosource would be the most reliable option.

A non-preferred generic drug is identified as Tier 2 in most plans. This means that it is not the first choice for a generic drug and may have a slightly higher copayment or coinsurance compared to Tier 1 drugs, which are the preferred generics. Tier 3 and Tier 4 drugs are typically brand-name drugs or specialty drugs, which are usually more expensive and have higher copayments or coinsurance.

Prescription drug plans do require a deductible to be paid for mail order. This means that individuals must pay a certain amount out of pocket before their insurance coverage kicks in for mail order prescriptions. Therefore, the statement that prescription drug plans do not require a deductible for mail order is incorrect.

The statement suggests that a customer has the option to change their CMS plan into a CMS Five-Star plan, but they can only do so once per CMS calendar year. This means that if a customer decides to switch to a CMS Five-Star plan, they need to carefully consider their decision as they will not be able to change their plan again until the next CMS calendar year. Therefore, the answer "True" indicates that the statement is correct.

The correct answers for this question are "You are a licensed guide" and "Your position is to make this transition easy and simple for our customers." These answers align with the role of a Business Analyst (BA) who assists in guiding and facilitating the transition process for customers, ensuring it is smooth and uncomplicated. The other options provided, such as providing biased recommendations or focusing on answering as many calls as possible, do not accurately describe the responsibilities of a BA.

The customer's drug is not covered because it is not listed in the formulary. This means that the drug is not included in the list of medications covered by the insurance plan. It is possible that the drug is not included in the formulary due to various reasons such as cost, risk factors, or other considerations.

The statement "enter the least amount of information to obtain the largest amount of records" is correct when searching for a record in the SSC. This means that by providing minimal information, the search will yield a larger number of results. This can be useful when trying to gather a broad range of records or when unsure about the specific details of the record being searched for.

Logging off is the correct way to turn off your computer at the end of the shift. When you log off, you are closing all your open applications and ending your session, allowing the computer to be used by someone else. This ensures that your work is saved and any personal information is protected. Restarting and locking the computer may not be necessary unless there are specific instructions to do so. Unplugging the computer and monitor is not recommended as it can cause data loss and potential damage to the hardware.

A non-preferred brand drug is identified as Tier 4 in most plans. This means that it is the highest tier level and usually comes with the highest cost-sharing for the insured individual. Tier 4 drugs are typically more expensive and may have cheaper alternatives available in lower tiers.

Retirees are not required to receive and complete the Getting Started Guide and the Enrollment Guide prior to enrolling in plans with One Exchange.

When a customer moves into or resides in a nursing home, they are granted a Special Enrollment Period (SEP) to change their Medicare Advantage or Prescription Drug Plan (PDP). This means that they have the flexibility to enroll in a different CMS plan at any time after moving into the nursing home. This allows them to make changes to their healthcare coverage based on their new living situation and healthcare needs.

If a customer suffers a loss of group coverage, he will have 2 months to enroll after the effective date for the loss of coverage. This means that the customer has a two-month window to enroll in a new coverage plan after experiencing a loss of group coverage.

BA's are not required to read the Medical Information Release (MIR) statement every time they talk with a retiree prior to asking Situation Analysis and prescription questions.

The statement suggests that the client's contact number can always be found in the client guide. However, the correct answer is false. This implies that the client's contact number may not always be available in the client guide.

If a customer is outside the service area for 6 months without notifying the carrier or Social Security, the carrier will cancel the plan. The customer will then have 3 months to enroll into a new plan. This means that after the cancellation of the previous plan, the customer has a window of 3 months to select and enroll in a new plan before they are left without coverage.

If a customer notifies a carrier or Social Security of a permanent move outside the plan's service area, they have 4 months to enroll into a different plan. This allows the customer enough time to make the necessary arrangements and find a new plan that will cover their healthcare needs in the new location.

To find a PCP number for a Humana MAPD, one should use the Humana Physician Finder. This resource specifically provides information about physicians affiliated with Humana, making it the most appropriate option for finding a PCP number. The NPI Registry may provide general information about healthcare providers, but it may not specifically list Humana-affiliated physicians. Calling the doctor's office is also a valid option, as they would have the most up-to-date and accurate information about their PCP numbers. Typing in the doctor's name and phone number in the notes is not a recommended resource for finding a PCP number, as it may not yield accurate results.